Audrey Clare Farley is a writer, editor, and scholar of 20th-century American culture with a special interest in science and religion. She earned a PhD in English literature at the University of Maryland, College Park. She now teaches a course on U.S. history at Mount St. Mary’s University.
Her first book, The Unfit Heiress: The Tragic Life and Scandalous Sterilization of Ann Cooper Hewitt, tells the story of a 1930s millionairess whose mother secretly sterilized her to deprive her of the family fortune, sparking a sensational case and forcing a debate of eugenics. Her second book, which we will be discussing today, Girls and Their Monsters: The Genain Quadruplets and the Making of Madness in America, explores the lives of the four women behind the National Institute of Mental Health’s famous case study of schizophrenia. It was named a New York Times Editors’ Pick and will be the focus of our conversation today.
Audrey’s essays have appeared in the Atlantic, New York Times, Washington Post, and many other outlets. She lives in Hanover, Pennsylvania.
The transcript below has been edited for length and clarity. Listen to the audio of the interview here.
Madison Natarajan: To start off, I want to talk a little bit about your background. You have a background in English literature and history. Yet, you have found your way to the psy-disciplines. Could you tell us a bit about how you found yourself at the intersection of these disciplines, and what drew you to the subject of your most recent book?
Audrey Farley: Well, it wasn’t deliberate or even conscious that I was finding myself in psychiatry. It so happened that I came across stories from history that really grabbed me and that happened to involve psychiatry. I recently graduated with my PhD, but like many people with a humanities degree was unable to land a tenure track job, so I was forced to find a second act for myself. I knew that I had always wanted to write a book, and I was just reading very widely and thinking about what I might be able to do.
I had come across the story of Anne Cooper Hewitt, and that really fascinated me. That book, I would say, a lot like Girls and Their Monsters, appealed to me because it was a really sensational story, but also one that was intellectually provocative. I really gravitate toward books that have a plot that can stand on its own two feet, but that also provide an occasion to think more deeply about America and particularly the underbelly of America, the things that we don’t learn in schools. I wrote that book, and then kind of came to this one with similar reasons of just being very alert by the story. It wasn’t conscious that I was coming to these stories of psychiatry.
Natarajan: I often find, as a psychologist in training, that the more work I do in this field, the more I feel like I also need to be a historian, have a background in political science, public health, and gender studies, etc., because when you think about what makes up the human psyche, it’s all of these things and more.
On that note, for those who maybe haven’t had a chance to read the book yet, could you give our listeners an overview of who the Genain Quadruplets are and how they fit into the world of psychiatry?
Farley: Yes, so the quadruplets were actually the Morloks, born in 1930 in Lansing, Michigan, to much fanfare. I write in the book from the day they were born, they belonged to other people, which I hope conveys how swiftly and aggressively the townsfolk laid claim to these girls. No sooner were their births announced than people began to gather outside the hospital, and then when the city provided them a house to live rent-free for a year, locals would come round the clock, they would peer in the windows even in the middle of the night. The pediatrician suggested that the mother charged 25 cents to at least make some money off of this whole thing.
People were indignant because they thought that they were already supporting these girls with their tax dollars. They would pay the fee and then be very angry if the mother refused to change their diapers upon request. They had this expectation that these girls were public property and that they really were this kind of carnival show.
When the sisters grew a little bit older, they began to have a singing and dancing act, which they took on the road. I’ll talk more about that, hopefully. They really had this reputation of being the “All-American family.” The newspapers, both locally and nationally, would write one puff piece after another about these girls—everything was picture-perfect, and there was a pageantry to their lives. But behind closed doors, their father really tormented them. The public also treated them as living dolls, both in the media stories about them and also in the way that even members of the community laid their hands on these girls. Several of them would be abused by community folk, not just their father.
By 1954, all four of them had been diagnosed with schizophrenia. This caught the attention of the National Institute of Mental Health (NIMH), which was newly formed and had a very interesting foundation in that NIMH was founded by Robert Felix, who was a social psychiatrist. He was interested in improving the social conditions for Americans such that fewer people suffered from mental illness. But at the same time, NIMH is joining these other National Institutes of Health, which are focused more on biological diseases. They’re studying cancer, for instance, and so there is this pressure that NIMH feels from the very beginning to prove that it is a hard science.
Not long after its founding, they hired a Scientific Director, Seymour Kety, whose expressed purpose was to develop the hard science of mental illness. He sets out to study the genetics of schizophrenia, through twins. This project was just getting underway when they got word that this family, which is not just twins, not just triplets, but quadruplets, have all been diagnosed with schizophrenia. Well, they could hardly believe their ears, so they swiftly arranged for the girls to be brought to Bethesda and studied, which they were for three years. The culmination of that research was David Rosenthal’s 1963 book, The Genain Quadruplets. Then, the girls were brought back for subsequent studies in the ’80s and then again in the ’90s.
Natarajan: How do you see the Morlok sisters and all of these studies influence genetic psychiatry?
Farley: Well, when they were brought to the NIMH in the 1950s, there was a fairly comprehensive team that was assigned to study them. More than 30 people were assigned to study the quadruplets, which is hard to conceive of today that there would be public monies for such a task, so they were studied by social workers and psychiatrists. Each girl was assigned to her own psychiatrist and sociologist. There was actually only one geneticist on the team.
It’s hard to make one single claim about the merit of the initial round of studies because it really was complicated. I did feel that the researchers tried to understand more than just the biology of these girls. But they were drifting towards things like the schizophrenogenic mother, which was a very popular theory at the time, which essentially posited that moms drove their children crazy, usually with this confusing communication. For instance, if a mother claimed she loved you, but every time you went to hug her, she flinched. Well, that could be confusing for a child, and then they could wonder, “Does she really love me?” They become paranoid, and so the theory went that could escalate into something resembling schizophrenia.
They were interested in the family. But I could see how they were really hindered by the popular theories of the day, which focused on the mother, for instance, when the father was the primary tormentor in this family. While they documented a lot of the abuse that the girls had endured, both at the hands of their father and even the community members, they didn’t really perceive that abuse as leading to mental illness. They would write, for instance, about how one of the girls was likely molested by a school janitor. But the attitude was that was bad, and it’s being documented here, but it’s not the etiology of this disease that they believed themselves to be studying.
Then as they came back in the 1980s, this is right when a lot of technology for studying the brain has been developed. and they were very eager to apply that new technology and new insights to the quadruplets. At that time, they were very singularly focused on the brain and its chemistry. They brought them back, they did all these blood tests and scans and things and asked very, very little about their lives. It turned out that they were still keeping secrets.
Natarajan: The longitudinal aspect of this study follows their lives as well as the shifts within psychiatry that were happening and the pivot in the 1980s, which was also when psychiatry adopted the disease model. You see that while maybe trauma and life events were accounted for and documented, you could tell that the field was shifting more towards trying to find an etiology within the brain that would have caused schizophrenia, and everything else was considered secondary.
Farley: Right. It was really shocking for me to speak with the sole surviving quadruplet’s son, David, because even as a young boy, he perceived that they were after something. He said, “They looked at me as some prodigy for future studies.” I quoted him in the book. He has very vivid memories of them putting the wires on his head and that sort of thing, but not asking any questions about his life. He was keeping his secrets, too, which were never accounted for in the NIMH research that grew out of the 1980s follow-up.
Natarajan: In the book, you do a really incredible job of situating the NIMH research and these women’s lives within their broader sociopolitical and historical context of this unique time in American history. I’m wondering how you see this backdrop of World War II, Nazi Germany, eugenics movements within medicine, as well as burgeoning Jim Crow and a new focus on what it means to have “traditional American values.” How did these all shape the circumstances of the research and, therefore, the Morlok sisters’ lives?
Farley: Well, here’s another way that the researchers were accounting for certain things, but not making meaning of them. If you read at the beginning of David Rosenthal’s book, he’s got about 100 pages where they’re just accounting for the girls’ lives. Within that family history, there were all of these details that struck me as so interesting and so important, but they weren’t making any meaning of them.
Just to give a few examples. When the quadruplets’ mother was pregnant, she perceived that she had more than one. She voiced this to her doctor, and the first words out of his mouth were, “Aren’t you a white woman?” Implying that only people of color are “hyperbreeders,” which is just totally of a piece with the eugenicist rhetoric of the day that people of color, immigrants, they’re animal-like and they’re hyperbreeders, and we need to intervene with things like forced sterilization and immigration restrictions and whatnot. Literally, even before the girls are born, they have been racially marked.
The book, The Genain Quadruplets of 1963, also talked about how their father’s mother believed that Germans were superior, and she really wanted her son, Karl, to marry someone with his own superior heritage. They had come over from Germany when Karl was only three years old. That detail was just also dropped into the narrative, but nothing was made of it. That’s where the literary scholar in me is thinking there’s a story within the story here that I need to draw out.
The quadruplets performed, they had this little sister act that they would take around the Midwest. Their performances very aggressively tried to yoke innocence with whiteness, Christianity, and Americanness. They would sing songs about Christopher Columbus and the founding of America. A lot of these songs had racial slurs in them. They also opened for minstrel performers. You can just imagine these little girls who are perfectly coiffed with their little blonde hair and their short skirts coming on stage and singing this cute little song about America. After their performance, men in blackface came on stage and rehearsed these really disgusting stereotypes about black men, such as that they are sexually barbarous. They’re after those little girls that were just on stage.
They are literally reenacting the logic of lynching. They’re on stage telling this narrative, which was supposedly undergirding Jim Crow, which is that black men are out to get our sweet little white girls, and that’s why we can’t have integrated schools, that’s why we can’t have integrated towns. That wasn’t even the end of it. Their father was a Nazi sympathizer. He had come from Germany, and he’d been told by his mother for many years that Germans were superior and people should marry within their own race. He was a segregationist. He thought that his girls were in danger by black men.
His obsession with the girl’s virginity was very much fueled by his fears of race mixing. But yet, the media stories were always portraying the girls as being these emblems of cheerful white American girlhood, and even during the war as fighters of fascism. They’ve got this dad who literally is hopeful that Hitler, once he’s done in Germany, is going to come over to the US and execute his plan here. But the newspapers were printing photographs of them participating in the Clean Plate Club, which is you eat all your food so as not to be wasteful and preserve food and resources for the soldiers, getting registered to vote. It’s like every civic milestone in their lives was accounted for. They were, by all accounts, shown to be these fighters of fascism, rather than, I would say, victims of another iteration of it here at home.
Natarajan: You’re speaking to a time in the US when there was a strong emphasis on attempting to protect the white race and keep it “pure.” This is also a period of anti-miscegenation laws, a time when our immigrant population is growing as discriminatory immigration bans lift, and racial demographics are changing as diversity is beginning to flourish a bit more in the United States. This put a larger emphasis on certain Americans wondering how to “protect the white race” in this changing racial landscape. The Morlok girls were the poster children of white racial innocence that all of this was being projected onto.
You and I spoke briefly on the subject of which books that talk about psychosis and schizophrenia are the ones that really take off and capture society’s attention. We noted that a lot of these books often adopt an apolitical approach, many times avoiding discussions that could politicize mental illness, presumably to make them more palatable to a wider audience. But this approach often leans on genetic and hereditary narratives to support this apolitical stance, and as you said, often accounting for but not making meaning of this broader context. I’m wondering your opinion on whether we can truly conduct “objective scientific research,” particularly within the psy-disciplines, without taking into account the sociopolitical context of the time.
Farley: That really fascinated me when I was doing research for the book and reading widely and just noticing which books are hitting the bestseller list and which ones have next to no reviews on Amazon. Which ones go viral, and which ones don’t? It did seem to me that the more popular books tended to depoliticize mental illness, so they would allow readers to gawk at this family or this person without asking much, if anything, of readers. This exact dynamic was recently explored in the New York Times review of Judith Herman’s most recent book, Trauma and Repair, and the review was written by Ellen Berry, who is one of the correspondents at the Times devoted to the coverage of mental health.
She alleged that Herman’s work never took off because of the way that it portrayed trauma as a social problem. That was in contrast to the work of Bessel van der Kolk (author of The Body Keeps the Score), who was a friend of Herman’s but whose work on trauma really tended to individualize it. She actually had this quote which I want to read. She says that “Herman’s approach is frankly political, rooted in the feminist movement, and unlikely to go viral on TikTok.” That’s it right there, in my opinion.
To answer the second part of your question, I don’t think that we can really get at these problems without the sociocultural context. That, in my mind, was one of the major flaws of the NIMH studies. When the researchers were presented by someone like Karl Morlok, they totally tried to write race and politics out of the story. Just to give an example, they used all these personality tests in the hopes of being able to identify the psychic hang-ups that these people had. They said that Karl had something called “authoritarian personality.” Well, yes, he’s a Nazi, but they’re trying to write that part out and identify these psychological hang-ups and neuroses absent of any real-world politics.
Natarajan: And if you don’t take that into account in the interpretation, then there’s this whole [political] underbelly of all of this that isn’t being acknowledged within the scientific literature.
Farley: Right. I think that the fact that the family was white is an added difficulty for a lot of readers, including psychiatrists and psychologists, who have read the book and say, well, “Racism in psychiatry is real, but this family was white.” Because they cannot see that whiteness is also a construction, right? We white folks are racially marked, too.
Natarajan: Yes. There is a tendency within the field and within the psy-disciplines to think only of people of color as having a race and a cultural identity that’s worth talking about. I think in a lot of our multicultural classes, it’s tagged onto the end as an afterthought, and we’re never really taught to look at whiteness as a race and whiteness as a culture. It’s kind of two sides of the same coin: on one side, there is racism, and on the other side, there is white supremacy. We often don’t like to talk about that, because the story here is about four white girls and a white family. It sounds like some readers have a hard time and are asking, “Well, why are you focusing on race? This is about a white family.”
Farley: Yes, and some readers are very angry, and they accuse me of “making it about race.” I put that in quotes. But I’m not the one that made these girls go on stage and open for minstrel performers. I’m analyzing what was already there.
Natarajan: I want to circle back to what we’ve been talking about related to trauma and more of the context that shapes this story. In some of your other interviews I’ve heard you refer to the Morlok sisters’ home as a “pathogenic home,” and it reminded me of Gabor Maté’s work on trauma. He uses this metaphor that within biology labs when you are studying organisms and cells, they are in a petri dish, and this dish is referred to as their culture. If the cell becomes sick, scientists know immediately to look to the culture first to understand what caused the cell to become diseased. But the very first assumption is that the culture became diseased, and therefore, the cell became sick. He uses this metaphor in his work about trauma and how our environments can be a factor in what makes us sick. Can you say more about this idea of the pathogenic home that the Morlok sisters grew up in and perhaps share your perspective on their psychological response to these traumas?
Farley: Well, interestingly, the initial research at NIMH was very focused on the family. There was one researcher there, Murray Bowen, who would go on to become famous for family systems theory. They were applying a lot of these different ideas and new insights to the girls. For instance, they had the idea that there was shared psychosis within the family. The family was so symbiotically involved with each other that when one girl started to become sick, it was like a domino effect because they were just so intricately connected to each other.
There was a lot of effort on the part of researchers to observe family interactions, even at NIMH. The staff members at the clinical center were encouraged to write down what they overheard between the parents and the sisters or between the sisters. You can imagine this orderly who looks like she’s doing something, but she’s actually eavesdropping on their conversation and then going and taking notes about it. This was all to understand the communication styles within the family and just the general health of the family unit. But again, as we’ve said, there was no effort to push beyond the family towards society. They don’t view this unit as mediating social norms or anything like that.
Natarajan: My sense, too, is that this focus on the family unit and understanding interactions still was also seen through kind of a sexist lens of looking at this idea of the schizophrenogenic mother and what mom was doing to [allegedly] cause some of these psychological stressors.
Farley: Right. Even though the father was arguably the worst off in the whole family, they blamed his issues both on the mother of the quadruplets and his own mother. They thought perhaps these women were so tyrannical that they emasculated him, and so his issues are because of these domineering women in his life.
Natarajan: At the time, too, there was a strong denial of sexual abuse that permeated psychoanalysis and psychiatry that the feminist movement and people like Judith Herman really brought to the forefront, even if it wasn’t mainstream at the time. The Morlok sisters experienced really unspeakable childhood traumas, including molestation, incest, and female mutilation, as adults, they experienced multiple sexual assaults. In your in-depth review of the various papers and publications on them, can you elaborate on the extent to which trauma was taken into consideration, or perhaps overlooked?
Farley: I think that it was largely overlooked. I mentioned how one of the sisters, Helen, was likely molested by the school janitor for many years. This was documented by the NIMH researchers, but they didn’t view it as leading to serious mental illness. When the sisters grew older, and they joined the workforce, they would encounter men out in the world who also just tried to harm them. In one case, a sister had survived an attempted assault in an elevator by a man who was wearing a brown suit. Shortly after this, she begins to hallucinate men in brown suits. You think about a detail like that, and it just seems so obvious that her psychosis has been set off by the sexual trauma, but that’s not how the researchers perceived it.
Natarajan: This goes back to what you said about trauma being accounted for and documented, but no meaning was made of it. If someone took the time to understand the hallucinations and delusions that they were having, it actually gave a pretty clear account of a trauma history, which also could have been grounds for important therapeutic work. And maybe even more importantly than an individual approach to that, what could have been done to protect them, what could the community have done, what could their family have done? I’m wondering what your work has taught you about the need for social repair for people to be able to heal and recover.
Farley: Well, going back to Judith Herman’s recent book, Trauma and Repair, that book makes a strong case for the need for communal repair. I think that that same idea applies here because the quadruplets’ abuse was communal. Even if we don’t consider the fact that they were molested by men outside the home, it was communal in the sense that the whole town agreed to look the other way and further forced these children to participate in a narrative that only certain people laid their hands on children. They were, in a way, participating in the charade which obscured their own abuse.
I really believe that when the abuse of children is communal, as it so clearly was, there needs to be communal repair, and that happens when all of us look inward and ask, “What biases do I have which are providing cover for child rapists?” What narratives do I spread that shroud abuse of children, which we now know is not as sensational as the media likes to pretend it is, right? It’s mundane. It’s in familiar spaces, at the hands of familiar people, brothers, fathers, uncles, priests, scout leaders.
Natarajan: You worked closely with Sarah Morlok, the only surviving sister, while writing this book. Something that stood out to me was that her son, David, clearly observed that while Sarah has been in remission from acute psychotic episodes for a while now, a trigger for her relapse into psychosis has been any time she visits or interacts with pastoral figures or clergy. Can you speak about this intersection of where religion and religious trauma also come into play with psychosis and schizophrenia?
Farley: Yes, that came out in one of my first conversations with David. He said that she was generally stable, and the only episodes that she had would be if a pastor came over to the house behind her back. That, of course, really struck me. He also spoke about how she would sometimes panic about hell and going to hell, and that was actually also documented by the NIMH researchers, but I think it was kind of written off as “They’re psychotic and they’re paranoid, so they’re paranoid about going to hell, it’s natural.” There was no effort to understand why they were afraid of going to hell. That was one of the ways that their father had actually tried to control them was by threatening hell.
Especially when they were of dating age, Karl would talk a lot about how if they thwarted his rules or did things behind his back, they were going to be burned for eternity. I could clearly see here that it wasn’t just this sexual abuse that they had endured, but religious abuse, which we’re only now having the vocabulary to talk about.
Natarajan: Yeah, which is interesting because I think religious undertones and spirituality show up often for people who experience what we would term “psychotic experiences.” But as a field, I think we’re barely just starting to think of that as a rich ground to unpack religious trauma and understand it a bit more. I often think about the religious undertones of a psychotic experience as being really pertinent to providing culturally responsive care, because religion is one of the biggest aspects of almost every culture, and so to not consider that piece of someone’s history, we’re really missing out on understanding their lived experience.
Often within the field, religion, and spirituality are focused on as protective factors, which certainly can be the case but is not always. I also think the Morlok sisters reclaim spirituality and religion for themselves. They go through their own deconstruction process and find a spirituality that is rooted in compassion and caring for the marginalized and the oppressed, and that is what they adopt later on in life when they have autonomy. But the religious foundation of this had been a lot of fear-mongering tactics to scare them into behaving in the ways that their father wanted them to behave.
Farley: Yes. I think that that was only possible after their father died, because of the way that the father figure and the God concept were so tightly yoked. If your father is this symbolic representation of God and your father is this sexual voyeur who’s spying on you—in the case of the quadruplets, standing in the doorway when they were in the bathroom, even changing their sanitary pads—then God is also a voyeur.
We see this with purity culture, too. A lot of people envision God as being so interested in what they’re doing in the bedroom, who’s always watching. When their father died, I think some of that was able to shift away from this idea of God as a voyeur towards an idea of God who is more loving and a protector.
Natarajan: I would love to hear you speak a bit more about what it was like for you to work with Sarah Morlok on this book. At Mad in America, we really value the perspective and expertise of service users and those with lived experience. I also want to take a moment just to honor Sarah Morlok and her sisters, Helen, Edna, and Wilma. Can you share with me a little bit about your relationship with Sarah as well as her son David and how that impacted you while writing this book?
Farley: Absolutely. Well, it’s interesting because I didn’t even know that she was alive when I set out to write the book. When I learned that she was, it was, of course, exciting to have this new research opportunity opened up, but it was also a great responsibility and a greater weight on my shoulders because I had to get the story right, I had to tell it in a way that was very respectful of her.
When I reached out to her, she was so curious that somebody had found her after all of these years because she had largely shifted out of public consciousness. She was very intrigued by me. For every question I asked of her, she would ask one of me, and so there was this kind of mutual getting to know each other.
Initially, she really wanted to keep up the narrative that they were this perfect family, but over time, I think that she was persuaded to see the merit of telling the truth. I told her very frankly that what was said about her in the papers was a caricature, it was flat, and it was fake, and it was, in many cases, written with very sinister motives. But I said to her, “You are a gift.” I think that she believed me and was able to see herself as having value, words and all, and even with all of the harder parts of the story, she gained the confidence for them to be on the page.
Actually, there was an insight that she had come to while she was at NIMH, and she was the only sister who had successful psychotherapy. She wrote, “I feel like I need to be perfect in order for people to like me.” That was her big breakthrough, one of them, in psychotherapy. I would remind her about that and say, “Remember, you don’t have to be perfect. Your family doesn’t have to be perfect. You are still a gift.” I’m just so grateful for her for having the courage to cooperate with me and to accompany me with the telling of the story.
It was her friendship, which was so life-giving that made it easier for me to write a book that was so very dark. It doesn’t have the ending that I wanted. There’s no justice for them. Three of them are dead. The father got away with it. The town got away with it. But she became such an important part of my life and even my family.
I love to tell two anecdotes if there’s time. She became so invested in my children’s lives. For instance, when my son was having a batting slump in baseball, she prayed really hard for him to get out of the batting slump and even recruited other people at her retirement home to pray for him. She had a little prayer chain going on, which he eventually did get a hit.
Then with my daughter, who she’s also very interested in because she’s young and was going to a middle school dance. One of the things that I trace in the book is how the quadruplets really loved to play beauty parlor at their house, even if they had nowhere to go. One of the sisters, Wilma, was the beautician. She actually went to beauty school but never finished, and they would get all dolled up just for themselves, and it was one of the most blissful things they did together.
When Sarah found out that my daughter was going to a dance, she gave me the beauty case that they had used from way back when. This thing had these dusty old objects from another time and place, like these little bobby pins and hair nets and combs that don’t look like combs. That was probably the most special gift of my life.
Natarajan: Such an honor that she shared that with you. It holds such a unique part of her memory with her sisters, and I think also speaks to their resilience—that they found joy and community among each other through play and through beauty and hair, despite the toxicity of the environment around them.
Farley: Yes, and you mentioned them reclaiming spirituality, too, and I think about how they would rearrange the furniture in the living room to resemble a church. One sister would play the piano, another one would give a sermon, and then they’d all go up for communion. Then, as soon as they heard the sounds of their father’s car, they would quickly rearrange the furniture so that it didn’t look like anything was out of place. That’s really beautiful to me. Even though they had a father who threatened hell, even though they attended a church that viewed unsubordinated women and feminists as being some of the world’s great evils, they really did cling to their faith in God and in each other, and that helped them through.
Natarajan: Well, Dr. Farley, thank you so much for your work on this book, and your time with me today. You’ve integrated a wide range of subjects like religion, race, eugenics, psychiatry, and trauma, which on their surface may seem disjointed or disconnected, but through the details of your work, you help make those connections and thereby make visible what is often made invisible. As a scholar of religious trauma myself and someone who works within psychiatric systems with individuals who are diagnosed with schizophrenia, your work has provided me with a resource in which to begin some of these conversations in multidisciplinary spaces, and so I’m so thankful for that.
Featured image provided by Audrey Clare Farley, depicting Audrey with Sarah Morlok.
MIA Reports are supported, in part, by a grant from The Thomas Jobe Fund.